| B-type natriuretic peptide-directed ultrafiltration improves care in acutely hospitalized dialysis patients. | |
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MedLine Citation:
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PMID: 19522962 Owner: NLM Status: In-Process |
Abstract/OtherAbstract:
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In an observational study in 19 consecutive acutely hospitalized dialysis patients, ultrafiltration (UF) volume was determined by B-type natriuretic peptide (BNP) levels. Patients were ultrafiltrated daily until they achieved a target BNP level <500 pg/mL. The UF volumes ranged from 2 to 5 L per session. All patients were male veterans aged 68+/-11 years (mean +/- SD), 74% were diabetic, 47% were African Americans, 58% underwent prevalent dialysis, and 53% had an arteriovenous fistula. Left ventricular ejection fraction on 2-dimensional echocardiography was 43.8%+/-27.9% (n=16). The admission BNP was 2412+/-1479 pg/mL (range, 561-5000 pg/mL) and BNP at hospital discharge was 1245+/-1173 pg/mL (range, 345-5000 pg/mL) (nonparametric Wilcoxon P=.0013). Admission weight was 88.9+/-27.9 kg and at discharge was 78.1+/-25.6 kg (P=.0002). The number of antihypertensive medications taken was 3.8+/-2.0 at admission and 2.3+/-1.7 at discharge (P=.0005). The number of patients with >2 blood pressure medications decreased from 14 to 6 (Fisher exact test, P=.02). The systolic/diastolic/mean arterial blood pressure decreased from admission to discharge (153.6+/-43.8/80.6+/-21.8/102.4+/-27.3 to 132.1+/-27.9/68.9+/-14.6/89.9+/-16.5 mm Hg; P=.0222/.0139/.0329, respectively). Although all patients were volume-overloaded at admission according to BNP criteria (>500), only 42% were identified as having heart failure. BNP-directed UF is safe because it minimizes symptomatic hypotension, identifies occult congestive heart failure in a large number of patients, and significantly reduces blood pressure in addition to reducing body weight and number of medications used. |
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Authors:
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Mihály Tapolyai; Aşkin Uysal; Gail Maeweathers; Elias Bahta; Neville R Dossabhoy |
Publication Detail:
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Type: Journal Article; Review |
Journal Detail:
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Title: Congestive heart failure (Greenwich, Conn.) Volume: 15 ISSN: 1751-7133 ISO Abbreviation: Congest Heart Fail Publication Date: 2009 May-Jun |
Date Detail:
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Created Date: 2009-06-15 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9714174 Medline TA: Congest Heart Fail Country: United States |
Other Details:
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Languages: eng Pagination: 131-5 Citation Subset: IM |
Affiliation:
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Division of Nephrology and Hypertension, Department of Medicine, Louisiana State University Health Sciences Center, 501 Kings Highway, Shreveport, LA, USA. mtapolyai@aol.com |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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